In NYC, COVID-19 outcomes not worse among patients with HIV
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Patients with HIV who were hospitalized with COVID-19 during the peak of the spring epidemic in New York City did not experience worse outcomes than patients without HIV who were hospitalized with COVID-19, researchers reported.
“As physicians caring for patients with HIV, we were concerned that this group might experience worse COVID-19 outcomes or more severe illness due to immune disturbances that have been associated with chronic HIV infection,” Keith Sigel, MD, PhD, MPH, associate professor of internal medicine and infectious diseases at the Icahn School of Medicine at Mount Sinai, told Healio.
“We wanted to know if we needed to counsel our patients on taking extra caution and if any additional risk stratification should be enacted when patients with HIV presented with COVID-19. We also wanted to determine if there were any differences in the presenting clinical characteristics for patients with HIV and COVID-19,” Sigel said.
Sigel and colleagues identified 88 patients with HIV hospitalized with laboratory-confirmed COVID-19 in five Mount Sinai hospitals between March 12 and April 23. According to the study, the researchers collected data on baseline clinical characteristics, laboratory values, HIV infection status, COVID-19 treatment and outcomes from this group of patients and demographically matched comparators to compare baseline clinical characteristics and outcomes.
They found that the patients with HIV had a similar likelihood of respiratory failure and death as the matched group of patients who presented during a similar point in the New York City epidemic, despite a much greater burden of comorbid illness. Poor outcomes for hospitalized patients with HIV were frequent but similar to proportions in comparator patients 18% required mechanical ventilation and 21% died during follow-up compared with 23% and 20%, respectively, according to Sigel and colleagues.
We found no evidence of worse COVID-19 outcomes for patients with HIV,” Sigel said. “People with HIV should take precautions related to COVID-19 disease similar to uninfected persons and should continue to adhere to prescribed HIV treatments. Patients with organ transplants and HIV infection may be at higher risk of death from COVID-19.”
A second study examined the severity of COVID-19 in patients with HIV receiving ART. Researchers included 77,590 participants from 60 HIV clinics in Spanish hospitals between Feb. 1 and April 15. According to the study, the researchers calculated estimated risks per 10,000 persons and assessed hospitalization, ICU admission and death rates.
Results showed that of the 77,590 PWH receiving ART, 236 were diagnosed with COVID-19. Of these patients, 151 were hospitalized, 15 were admitted to the ICU and 20 died.
According to the study, the risks for COVID-19 diagnosis and hospitalization were greater in men and those older than 60 years, whereas the risk for COVID-19-related hospitalization was 10.5 per 10,000 people (95% CI, 5.6-17.9) among those receiving tenofovir disoproxil fumarate/emtricitabine compared with 20.3 (95% CI, 15.2-26.7) among patients receiving tenofovir alafenamide/emtricitabine and 23.4 (95% CI, 17.2-31.1) among those receiving abacavir/lamivudine and 20 (95% CI, 14.2-27.3) for those receiving other regimens.
“We took advantage of the overlap between two ongoing pandemics in Spain. Our results suggest that the risk for COVID-19 diagnosis is not higher in HIV-positive persons than in the general population, and that HIV-positive patients receiving tenofovir disoproxil fumarate/emtricitabine had a lower risk for COVID-19 and related hospitalization than other HIV-positive persons,” Julia del Amo, MD, PhD, director of the National Plan on HIV/STIs for Spain, and colleagues wrote. “These findings warrant further investigation in studies of HIV pre-exposure prophylaxis and in randomized trials for the treatment and prevention of COVID-19 in persons without HIV.”
References:
- Del Amo, J, et al. Ann Intern Med. 2020;doi:10.7326/M20-3689.
- Sigel K, et al. Clin Infect Dis. 2020;doi:10.1093/cid/ciaa880.
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